Gary A Smith’s research while affiliated with The Ohio State University and other places

Introduction This study investigated the characteristics and trends of pediatric exposures to caffeine energy products reported to US poison centers Methods National Poison Data System data for caffeine energy product single-substance exposures during 2011–2023 among individuals < 20 years old were analyzed. Results There were 32,482 caffeine energy product exposures reported to US poison centers with a 17.3% exposure rate increase during 2011–2023. Most exposures were among < 6-year-olds (69.6%), males (56.7%), or involved liquid formulations (57.5%). Most (80.7%) were not treated in a healthcare facility; however, 1.6% were medically admitted. Teenagers 13–19 years old were more likely to be medically admitted (OR = 12.74, 95% CI: 10.40–15.60) or have a serious medical outcome (OR = 18.83, 95% CI: 16.88–21.01) than children < 13 years old. Solid energy product formulations were more likely to be associated with a serious medical outcome (OR = 1.98, 95% CI: 1.81–2.17) or medical admission (OR = 5.23, 95% CI: 4.31–6.36) than other types of formulations. During the study period, exposure rates increased for liquid (34.5%) and powder/granules (632.9%) product formulations but decreased for solids (-51.5%). Among liquid formulation subcategories, the exposure rate for beverages increased (46.5%) and that for shots decreased (-86.1%). Conclusions Although most pediatric exposures to caffeine energy products reported to US poison centers were associated with no or minimal clinical effects, serious medical outcomes and medical admissions occurred. The product formulations that drove the 17% increase in the exposure rate changed during the study period. Opportunities exist to reduce the adverse effects of caffeine energy products among the pediatric population.

The objective of this study was to investigate the characteristics and trends of therapeutic errors in non‐healthcare facility settings associated with antithrombotic medications reported to United States Poison Centers by analyzing data from the National Poison Data System from 2000 to 2021. There were 57 288 reported therapeutic error‐related exposures involving antithrombotic medications as the primary substance. The rate of therapeutic errors increased by 590.9% during this 22‐year period. Although most (90.1%) therapeutic errors were clinically inconsequential and did not receive treatment at a healthcare facility, 2.3% were medically admitted, and 2.1% experienced a serious medical outcome, including 16 fatalities. Three‐fourths (74.9%) of therapeutic errors were among > 59‐year‐olds, and females represented 58.0% of exposures. Warfarin was the most commonly involved antithrombotic medication (37.5%), followed by direct oral anticoagulants (DOACs, 28.7%) and clopidogrel (23.3%). Therapeutic errors involving warfarin were more likely to be associated with a medical admission (odds ratio [OR] = 2.23; 95% confidence interval [CI]: 1.99–2.49) or a serious medical outcome (OR = 2.99; 95% CI: 2.65–3.37), and DOACs were less likely to be associated with a medical admission (OR = 0.53, 95% CI: 0.46–0.61) or a serious medical outcome (OR = 0.45; 95% CI: 0.38–0.53) than therapeutic errors involving other antithrombotic medications. The rate of therapeutic errors involving warfarin significantly increased by 187.0% during 2000–2011, followed by a 57.6% significant decrease during 2011–2021. The rate of therapeutic errors involving DOACs increased significantly by 1118.2% during 2011–2021. The scenario “inadvertently took/given medication twice” accounted for 56.3% of all therapeutic errors. Increased risk reduction efforts are needed to prevent antithrombotic‐related therapeutic errors.

Tianeptine is an atypical tricyclic antidepressant not approved for medical use in the US but is found in dietary supplements. This study investigates single-substance tianeptine exposures reported to US poison centers. We analyzed cases involving tianeptine reported to the National Poison Data System from 2015 to 2023. There were 892 single-substance tianeptine exposures reported to US poison centers from 2015 to 2023, and the rate of exposures increased 1,400% from 2015 to 2023, including a 525% increase from 2018 to 2023. Most exposures were associated with moderate (51.5%) or major (12.0%) effects, and 40.1% required medical admission, including 22.9% to a critical care unit. Individuals 50 years and older were more likely to experience major effects (RR: 1.70, 95% CI: 1.13–2.56) or require medical admission (RR: 1.43, 95% CI: 1.20–1.72) than younger individuals. Tianeptine abuse accounted for 40.1% of exposures and was more likely to be associated with moderate or major effects (RR: 1.18, 95% CI: 1.06–1.31) than exposures not attributed to abuse. Withdrawal accounted for 22.5% of tianeptine exposures. Tianeptine exposure rates were highest in the US South. Alabama enacted legislation to regulate tianeptine as a controlled substance in 2021. Alabama’s tianeptine exposure rate increased by 1,413.7% from 2018 to 2021, followed by a 74.6% decrease from 2021 to 2023, while the rate in other southern states continued to increase. This study demonstrates the toxicity and rapid increase of tianeptine exposures reported to US poison centers. Uniform regulation of tianeptine across all states may offer an important strategy to help mitigate this public health problem.

Objectives: Washington State implemented a new policy in 2004 that allowed drivers younger than 70 years old to renew their driver license by mail or online at every other renewal. Drivers aged 70 years and older were still required to renew in-person every 6 years. The purpose of this study was to evaluate whether this policy change was associated with motor vehicle crash (MVC) injury and fatality among drivers, non-drivers, and all road users aged 45-69 years. Methods: Controlled interrupted time series analysis models were fit to compare injury and fatality rates for these road users affected by the requirement to older road users not affected by the requirement (70 years and older). Differential level and slope changes in injury and fatality rates were used to estimate associations with the change in the license renewal requirement. Results: We did not find evidence that implementation of online driver license renewal in Washington was associated with increased injury or fatality rates among drivers, non-drivers, or all road users aged 45-69 years relative to those aged 70 years and older. Conclusions: Allowing driver license renewal online or by mail at every other renewal appears to be a safe strategy for less restrictive driver licensing for drivers aged 45-69 years. Future research should continue to evaluate the potential impacts of in-person and online renewal policies.

Background Gabapentin and pregabalin were originally introduced as anticonvulsant medications but are now also prescribed on- and off-label for multiple medical disorders, especially for pain management. The national opioid crisis has led to increased use of non-opioid pain medications, including gabapentinoids, which has been associated with changing patterns of adverse events associated with these medications. This study investigated the characteristics and trends of gabapentin and pregabalin exposures reported to US poison centers from 2012 to 2022. Methods National Poison Data System data involving gabapentin and pregabalin exposures for 2012 to 2022 were analyzed. Results There were 124,161 exposures involving gabapentin and pregabalin as the primary substance reported to US poison centers during the study period. Most exposures involved gabapentin (85.9%), females (59.4%), single-substance exposures (62.9%), or occurred at a residence (97.2%). Suspected suicides accounted for 45.2% of exposures. Most exposures were associated with a minor effect (27.4%) or no effect (34.0%), while 22.1% experienced a serious medical outcome, including 96 fatalities. The rate of gabapentin and pregabalin exposures per one million US population increased by 236.1% from 22.7 in 2012 to 76.5 in 2019 ( P < 0.001), followed by a non-significant decrease to 68.5 in 2022 ( P = 0.068). Conclusions The rate of gabapentin and pregabalin exposures reported to US poison centers increased by more than 230% from 2012 to 2019 before plateauing from 2019 to 2022. The observed rate trend was driven primarily by gabapentin exposures and by cases associated with suspected suicide. Although most exposures were associated with a minor or no effect, 22% of individuals experienced a serious medical outcome, including 96 fatalities. These findings contribute to the discussion of rescheduling gabapentin as a federally controlled substance, which is the current status of pregabalin. Prevention of suicide associated with gabapentin and pregabalin merits special attention.

Background The prevalence of xylazine, a non-opioid tranquilizer not for human consumption, in illicitly manufactured fentanyl is increasing in the United States. However, little is known about xylazine awareness and attitudes among people who use drugs. Methods A cross-sectional survey of people who use drugs in Ohio was conducted from November 2023 – May 2024 to identify xylazine awareness and attitudes in rural and urban counties across the state. Study participants were recruited from naloxone distribution sites, including health departments, syringe service programs, and community-based organizations. Results Among 630 people who use drugs in Ohio, more than one-half (53.5%) were unaware of xylazine being in “street drugs,” regardless of urbanicity. Among individuals who were aware of xylazine, most (73.0%) indicated they did not want to use the drug and try to avoid it. In addition, 75.8% of this group felt it was “very” or “extremely” important to know if xylazine was in their drugs. Discussion This research found that many people who use drugs in Ohio are unaware of xylazine and its risks. An important finding of this study is that most individuals who had heard of xylazine did not want to use it and were concerned about knowing whether xylazine was in their drugs.

Background To investigate the characteristics and trends of therapeutic errors that occur outside of healthcare facilities involving diabetes medications reported to US poison centers. Methods National Poison Data System data from 2000 to 2021 were retrospectively analyzed. Results There were 157,623 exposure cases of non-healthcare facility-related therapeutic errors associated with diabetes medications as the primary substance reported to US poison centers from 2000 to 2021. The rate of all therapeutic errors involving diabetes medications increased by 279.8% from 2000 to 2011, followed by a slower 15.0% increase to 2021. Half (50.1%) of the exposure cases were treated/evaluated and released and 44.1% did not receive treatment in a healthcare facility; however, 9.9% experienced a serious medical outcome, including 17 fatalities, and 1.0% were admitted to a critical care unit and 2.2% to a non-critical care unit. Insulin had the highest rates of therapeutic errors and serious medical outcomes, while sulfonylureas and insulin had the highest medical hospital admission rates. Metformin accounted for 59% ( n = 10) of fatalities. Conclusions Although most cases of therapeutic errors involving diabetes medications had no or minimal clinical consequences, an important minority were associated with a serious medical outcome or medical hospital admission. Increased efforts to prevent therapeutic errors involving diabetes medications are warranted.

Background Opioid-related fatalities are a leading cause of death in Ohio and nationally, with an increasing number of overdoses attributable to fentanyl. Rapid fentanyl test strips can identify fentanyl and some fentanyl analogs in urine samples and are increasingly being used to check illicit drugs for fentanyl before they are used. Fentanyl test strips are a promising harm reduction strategy; however, little is known about the real-world acceptability and impact of fentanyl test strip use. This study investigates fentanyl test strip distribution and education as a harm reduction strategy to prevent overdoses among people who use drugs. Methods The research team will recruit 2400 individuals ≥ 18 years with self-reported use of illicit drugs or drugs purchased on the street within the past 6 months. Recruitment will occur at opioid overdose education and naloxone distribution programs in 16 urban and 12 rural Ohio counties. Participating sites will be randomized at the county level to the intervention or non-intervention study arm. A brief fentanyl test strip educational intervention and fentanyl test strips will be provided to participants recruited from sites in the intervention arm. These participants will be eligible to receive additional fentanyl test strips for 2 years post-enrollment. Participants recruited from sites in the non-intervention arm will not receive fentanyl test strip education or fentanyl test strips. All participants will be followed for 2 years post-enrollment using biweekly, quarterly, and 6-month surveys. Primary outcomes include (1) identification of perceived barriers and facilitating factors associated with incorporating fentanyl test strip education and distribution into opioid overdose education and naloxone distribution programs; (2) differences in knowledge and self-efficacy regarding how to test drugs for fentanyl and strategies for reducing overdose risk between the intervention and non-intervention groups; and (3) differences in non-fatal and fatal overdose rates between the intervention and non-intervention groups. Discussion Findings from this cluster randomized controlled trial will contribute valuable information about the feasibility, acceptability, and impact of integrating fentanyl test strip drug checking in rural and urban communities in Ohio and help guide future overdose prevention interventions. Trial registration ClinicalTrials.gov NCT05463341. Registered on July 19, 2022. https://clinicaltrials.gov/study/NCT05463341

Introduction This study investigated exposures involving ∆8-tetrahydrocannabinol (∆8-THC) reported to US poison centers (PCs), including variation among states and regions. It evaluated whether the ∆8-THC exposure rate was lower among states with ∆8-THC regulations and states where cannabis (∆9-THC) use was legal. Methods National Poison Data System data for ∆8-THC exposures in 2021–2022 were analyzed, including comparisons of state and regional population-based exposure rates. Results There were 4,925 exposures involving ∆8-THC as the primary substance reported to US PCs from January 1, 2021, to December 31, 2022, with 69.8% of these reported in the US South. The rate of exposure per 100,000 US population increased by 79.2% from 0.53 in 2021 to 0.95 in 2022. In 2022, the mean rate of ∆8-THC exposures in states where cannabis use was illegal was 1.64 per 100,000 population (95% CI: 1.08–2.20) compared with 0.52 (95% CI: 0.29–0.76) in states where cannabis use was legal ( P = 0.0010). In 2022, the mean rate of ∆8-THC exposures in states where ∆8-THC was unregulated was 1.36 per 100,000 population (95% CI: 0.95–1.77) compared with 0.17 (95% CI: 0.06–0.27) in states where ∆8-THC was banned ( P < 0.0001). Conclusions The rate of ∆8-THC exposures reported to US PCs increased by 79% from 2021 to 2022, with the US South accounting for more than two-thirds of exposures. The rate of ∆8-THC exposures reported to PCs was significantly lower among states where ∆8-THC was banned and among states where cannabis use was legal. Consistent regulation of ∆8-THC across all states should be adopted.